Provider Demographics
NPI:1952319964
Name:C STEPHEN GOETZ MD INC
Entity Type:Organization
Organization Name:C STEPHEN GOETZ MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-966-6444
Mailing Address - Street 1:6401 COYLE AVE
Mailing Address - Street 2:#315
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0310
Mailing Address - Country:US
Mailing Address - Phone:916-966-6444
Mailing Address - Fax:916-966-9077
Practice Address - Street 1:6401 COYLE AVE
Practice Address - Street 2:#315
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0310
Practice Address - Country:US
Practice Address - Phone:916-966-6444
Practice Address - Fax:916-966-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA632226207N00000X, 207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06024ZOtherMEDICARE PTAN
CAZZZ06024ZOtherMEDICARE PTAN